Donate Help Contact The AHA Sign In Home
American Heart Association
Circulation
Search: search_blue_button Advanced Search
Published Online
on August 4, 2003

Circulation. 2003
Published online before print August 4, 2003, doi: 10.1161/01.CIR.0000084544.54513.E2
A more recent version of this article appeared on August 19, 2003
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
108/7/844    most recent
01.CIR.0000084544.54513.E2v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Torbicki, A.
Right arrow Articles by Wawrzynska, L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Torbicki, A.
Right arrow Articles by Wawrzynska, L.
Right arrowPubmed/NCBI databases
*OMIM
Medline Plus Health Information
*Pulmonary Hypertension
Related Collections
Right arrow Contractile function
Right arrow Other myocardial biology
Right arrow Other heart failure
Right arrow Apoptosis
Right arrow Risk Factors
Right arrow Calcium cycling/excitation-contraction coupling
Right arrow Cell biology/structural biology
Right arrow Energy metabolism
Right arrow Heart failure - basic studies
Right arrow Pulmonary biology and circulation
Right arrow Pulmonary circulation and disease

Submitted on March 31, 2003
Revised on May 8, 2003
Accepted on May 9, 2003

Detectable Serum Cardiac Troponin T as a Marker of Poor Prognosis Among Patients With Chronic Precapillary Pulmonary Hypertension

Adam Torbicki MD*, Marcin Kurzyna MD, Pawel Kuca MD, Anna Fijalkowska MD, Jaroslaw Sikora MD, Michal Florczyk MD, Piotr Pruszczyk MD, Janusz Burakowski MD, and Lilianna Wawrzynska MD

From the Department of Chest Medicine, Institute of Tuberculosis and Lung Diseases, and Department of Internal Medicine and Hypertension (P.P.), Medical University of Warsaw, Poland.

* To whom correspondence should be addressed. E-mail: torbi{at}pol.pl.

Background--Right ventricular failure is a leading cause of death in patients with chronic pulmonary hypertension (PH). We checked whether detection of cardiac troponin T (cTnT), a specific marker of myocyte injury, could be useful in prognostic stratification of those patients.

Methods and Results--Initial evaluation of 56 clinically stable patients (age 41±15 years) with pulmonary arterial (51 patients) or inoperable chronic thromboembolic (5 patients) PH (mean pulmonary arterial pressure 60±18 mm Hg) included cTnT test, allowing detection of its serum levels >=0.01 ng/mL [cTnT(+)]. cTnT was detectable in 8 of 56 (14%) patients (mean±SD, 0.034±0.022; range, 0.010 to 0.077 ng/mL). Despite similar pulmonary hemodynamics, they had higher heart rate (92±15 versus 76±14 bpm, P=0.004), lower mixed venous oxygen saturation (50±10% versus 57±9%, P=0.04), and higher serum N-terminal pro-B-type natriuretic peptide (4528±3170 versus 2054±2168 pg/mL, P=0.03) and walked less during the 6-minute walk test (298±132 versus 396±101 m, P=0.02). Cumulative survival estimated by Kaplan-Meier curves was significantly worse at 24 months in cTnT(+) compared with cTnT(-) (29% versus 81%, respectively, log-rank test P=0.001). Multivariate analysis revealed cTnT status (hazard ratio, 4.89; 95% CI, 1.18 to 20.29; P=0.03), 6-minute walk test (hazard ratio, 0.93 for each 10 m; P=0.01), and pulmonary vascular resistance (hazard ratio, 1.13; P=0.01) as independent markers of mortality. All 3 cTnT(+) patients who survived the follow-up period converted to cTnT(-) during treatment.

Conclusions--Detectable cTnT is a so-far ignored independent marker of increased mortality risk in patients with chronic precapillary PH, supporting the role of progressive myocyte injury in the vicious circle leading to hemodynamic destabilization.
Key words: prognosis • hypertension • pulmonary • ventricles • ischemia • heart failure




This article has been cited by other articles:


Home page
 Eur Respir JHome page
The Task Force for the Diagnosis and Treatment of, N. Galie, M. M. Hoeper, M. Humbert, A. Torbicki, J-L. Vachiery, J. A. Barbera, M. Beghetti, P. Corris, S. Gaine, et al.
Guidelines for the diagnosis and treatment of pulmonary hypertension
Eur. Respir. J., December 1, 2009; 34(6): 1219 - 1263.
[Full Text] [PDF]

Home page
 Clin. Chem.Home page
W. E. Kelley, J. L. Januzzi, and R. H. Christenson
Increases of Cardiac Troponin in Conditions other than Acute Coronary Syndrome and Heart Failure
Clin. Chem., December 1, 2009; 55(12): 2098 - 2112.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
Authors/Task Force Members, N. Galie, M. M. Hoeper, M. Humbert, A. Torbicki, J.-L. Vachiery, J. A. Barbera, M. Beghetti, P. Corris, S. Gaine, et al.
Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT)
Eur. Heart J., October 2, 2009; 30(20): 2493 - 2537.
[Full Text] [PDF]

Home page
 ERRHome page
J-L. Vachiery and G. Coghlan
Screening for pulmonary arterial hypertension in systemic sclerosis
Eur. Respir. Rev., September 1, 2009; 18(113): 162 - 169.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
A. J. Peacock, R. Naeije, N. Galie, and L. Rubin
End-points and clinical trial design in pulmonary arterial hypertension: have we made progress?
Eur. Respir. J., July 1, 2009; 34(1): 231 - 242.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
V. V. McLaughlin, D. B. Badesch, M. Delcroix, T. R. Fleming, S. P. Gaine, N. Galie, J. S. R. Gibbs, N. H. Kim, R. J. Oudiz, A. Peacock, et al.
End Points and Clinical Trial Design in pulmonary arterial hypertension.
J. Am. Coll. Cardiol., June 30, 2009; 54(1 Suppl): S97 - 107.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
V. V. McLaughlin, S. L. Archer, D. B. Badesch, R. J. Barst, H. W. Farber, J. R. Lindner, M. A. Mathier, M. D. McGoon, M. H. Park, R. S. Rosenson, et al.
ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association Developed in Collaboration With the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association
J. Am. Coll. Cardiol., April 28, 2009; 53(17): 1573 - 1619.
[Full Text] [PDF]

Home page
 CirculationHome page
Writing Committee Members, V. V. McLaughlin, S. L. Archer, D. B. Badesch, R. J. Barst, H. W. Farber, J. R. Lindner, M. A. Mathier, M. D. McGoon, M. H. Park, et al.
ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: Developed in Collaboration With the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association
Circulation, April 28, 2009; 119(16): 2250 - 2294.
[Full Text] [PDF]

Home page
 ESC Textbook of Cardiovascular MedicineHome page
N. Galiè and A. Manes
CHAPTER 24 Pulmonary Hypertension
ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
I. R. Henkens, C. T.-J. Gan, S. A. van Wolferen, M. Hew, A. Boonstra, J. W. R. Twisk, O. Kamp, E. E. van der Wall, M. J. Schalij, A. Vonk Noordegraaf, et al.
ECG Monitoring of Treatment Response in Pulmonary Arterial Hypertension Patients
Chest, December 1, 2008; 134(6): 1250 - 1257.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
S. Rich and M. Rabinovitch
Diagnosis and Treatment of Secondary (Non-Category 1) Pulmonary Hypertension
Circulation, November 18, 2008; 118(21): 2190 - 2199.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
G. Warwick, P. S. Thomas, and D. H. Yates
Biomarkers in pulmonary hypertension
Eur. Respir. J., August 1, 2008; 32(2): 503 - 512.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
S. E. Orfanos and S. Zakynthinos
Heart biomarkers as prognostic tools for chronic thromboembolic pulmonary hypertension: a step forward by the fatty acid-binding protein
Eur. Respir. J., May 1, 2008; 31(5): 915 - 917.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
M. Lankeit, C. Dellas, A. Panzenbock, N. Skoro-Sajer, D. Bonderman, M. Olschewski, K. Schafer, M. Puls, S. Konstantinides, and I. M. Lang
Heart-type fatty acid-binding protein for risk assessment of chronic thromboembolic pulmonary hypertension
Eur. Respir. J., May 1, 2008; 31(5): 1024 - 1029.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
F. Haddad, S. A. Hunt, D. N. Rosenthal, and D. J. Murphy
Right Ventricular Function in Cardiovascular Disease, Part I: Anatomy, Physiology, Aging, and Functional Assessment of the Right Ventricle
Circulation, March 18, 2008; 117(11): 1436 - 1448.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
P. H. Brekke, T. Omland, S. H. Holmedal, P. Smith, and V. Soyseth
Troponin T elevation and long-term mortality after chronic obstructive pulmonary disease exacerbation
Eur. Respir. J., March 1, 2008; 31(3): 563 - 570.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
National Pulmonary Hypertension Centres of the UK
Consensus statement on the management of pulmonary hypertension in clinical practice in the UK and Ireland
Heart, March 1, 2008; 94(Suppl_1): i1 - i41.
[Full Text] [PDF]

Home page
 ThoraxHome page
National Pulmonary Hypertension Centres of the UK
Consensus statement on the management of pulmonary hypertension in clinical practice in the UK and Ireland
Thorax, March 1, 2008; 63(Suppl_2): ii1 - ii41.
[Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
S. G. Haworth
The cell and molecular biology of right ventricular dysfunction in pulmonary hypertension
Eur. Heart J. Suppl., December 1, 2007; 9(suppl_H): H10 - H16.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
J.G. Coghlan and J. Davar
How should we assess right ventricular function in 2008?
Eur. Heart J. Suppl., December 1, 2007; 9(suppl_H): H22 - H28.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
M. Kurzyna and A. Torbicki
Neurohormonal modulation in right ventricular failure
Eur. Heart J. Suppl., December 1, 2007; 9(suppl_H): H35 - H40.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
A. Fijalkowska and A. Torbicki
Role of cardiac biomarkers in assessment of RV function and prognosis in chronic pulmonary hypertension
Eur. Heart J. Suppl., December 1, 2007; 9(suppl_H): H41 - H47.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
N. Galie, A. Manes, M. Palazzini, L. Negro, S. Romanazzi, and A. Branzi
Pharmacological impact on right ventricular remodelling in pulmonary arterial hypertension
Eur. Heart J. Suppl., December 1, 2007; 9(suppl_H): H68 - H74.
[Abstract] [Full Text] [PDF]

Home page
 haematolHome page
E. Voskaridou, G. Tsetsos, A. Tsoutsias, E. Spyropoulou, D. Christoulas, and E. Terpos
Pulmonary hypertension in patients with sickle cell/{beta} thalassemia: incidence and correlation with serum N-terminal pro-brain natriuretic peptide concentrations
Haematologica, June 1, 2007; 92(6): 738 - 743.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
S. A. van Wolferen, J. T. Marcus, A. Boonstra, K. M.J. Marques, J. G.F. Bronzwaer, M. D. Spreeuwenberg, P. E. Postmus, and A. Vonk-Noordegraaf
Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension
Eur. Heart J., May 2, 2007; 28(10): 1250 - 1257.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
N. F. Voelkel, R. A. Quaife, L. A. Leinwand, R. J. Barst, M. D. McGoon, D. R. Meldrum, J. Dupuis, C. S. Long, L. J. Rubin, F. W. Smart, et al.
Right Ventricular Function and Failure: Report of a National Heart, Lung, and Blood Institute Working Group on Cellular and Molecular Mechanisms of Right Heart Failure
Circulation, October 24, 2006; 114(17): 1883 - 1891.
[Full Text] [PDF]

Home page
 ChestHome page
A. Fijalkowska, M. Kurzyna, A. Torbicki, G. Szewczyk, M. Florczyk, P. Pruszczyk, and M. Szturmowicz
Serum N-Terminal Brain Natriuretic Peptide as a Prognostic Parameter in Patients With Pulmonary Hypertension
Chest, May 1, 2006; 129(5): 1313 - 1321.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
M. Maeder, T. Fehr, H. Rickli, and P. Ammann
Sepsis-Associated Myocardial Dysfunction: Diagnostic and Prognostic Impact of Cardiac Troponins and Natriuretic Peptides
Chest, May 1, 2006; 129(5): 1349 - 1366.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
L. Babuin and A. S. Jaffe
Troponin: the biomarker of choice for the detection of cardiac injury
Can. Med. Assoc. J., November 8, 2005; 173(10): 1191 - 1202.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
A. Jeremias and C. M. Gibson
Narrative Review: Alternative Causes for Elevated Cardiac Troponin Levels when Acute Coronary Syndromes Are Excluded
Ann Intern Med, May 3, 2005; 142(9): 786 - 791.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
E. Bossone, B. D. Bodini, A. Mazza, and L. Allegra
Pulmonary Arterial Hypertension: The Key Role of Echocardiography
Chest, May 1, 2005; 127(5): 1836 - 1843.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
R. Souza, H. B. Bogossian, M. Humbert, C. Jardim, R. Rabelo, M. B. P. Amato, and C. R. R. Carvalho
N-terminal-pro-brain natriuretic peptide as a haemodynamic marker in idiopathic pulmonary arterial hypertension
Eur. Respir. J., March 1, 2005; 25(3): 509 - 513.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
Task Force members, N. Galie, A. Torbicki, R. Barst, P. Dartevelle, S. Haworth, T. Higenbottam, H. Olschewski, A. Peacock, G. Pietra, et al.
Guidelines on diagnosis and treatment of pulmonary arterial hypertension: The Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology
Eur. Heart J., December 2, 2004; 25(24): 2243 - 2278.
[Full Text] [PDF]

Home page
 CirculationHome page
S. Velez-Roa, A. Ciarka, B. Najem, J.-L. Vachiery, R. Naeije, and P. van de Borne
Increased Sympathetic Nerve Activity in Pulmonary Artery Hypertension
Circulation, September 7, 2004; 110(10): 1308 - 1312.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
M. Kemp, J. Donovan, H. Higham, and J. Hooper
Biochemical markers of myocardial injury
Br. J. Anaesth., July 1, 2004; 93(1): 63 - 73.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. J. Barst, M. McGoon, A. Torbicki, O. Sitbon, M. J. Krowka, H. Olschewski, and S. Gaine
Diagnosis and differential assessment of pulmonary arterial hypertension
J. Am. Coll. Cardiol., June 16, 2004; 43(12_Suppl_S): 40S - 47S.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. M. Hoeper, R. J. Oudiz, A. Peacock, V. F. Tapson, S. G. Haworth, A. E. Frost, and A. Torbicki
End points and clinical trial designs in pulmonary arterial hypertension: Clinical and regulatory perspectives
J. Am. Coll. Cardiol., June 16, 2004; 43(12_Suppl_S): 48S - 55S.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
A. Peacock, R. Naeije, N. Galie, and J.T. Reeves
End points in pulmonary arterial hypertension: the way forward
Eur. Respir. J., June 1, 2004; 23(6): 947 - 953.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. R. Wilkins
Selective or Nonselective Endothelin Receptor Blockade in Pulmonary Arterial Hypertension
Am. J. Respir. Crit. Care Med., February 15, 2004; 169(4): 433 - 434.
[Full Text] [PDF]


Circulation Home | Subscriptions | Archives | Feedback | Authors | Help | AHA Journals Home | Search
Copyright © 2003 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.